AB0836 Micronutrients deficiencies in Enteropathic Spondyloarthritis: the interplay with metabolism and HLA-B27 in disease phenotype
Authors: P. Triggianese, A. D’Antonio, E. Manna, M. Fatica, G. Raffone, P. Conigliaro, E. Lolli, E. Calabrese, L. Biancone, A. Bergamini, M. S. Chimenti
Journal: Annals of the Rheumatic Diseases (2022)

Background Micronutrients play immunomodulatory roles through interactions with innate and adaptive immunity influencing the pro/anti-inflammatory balance. Serum levels depend on multiple factors such as gender, nutrition, and gut microbiome. Micronutrient deficiencies (MNDs) are associated with a pro-inflammatory status and co-morbidities in patients with chronic inflammatory diseases. No studies focused on potential interplay between MNDs and disease phenotype in Enteropathic Spondyloarthritis (ESpA) in which the combination of SpA with inflammatory bowel diseases (IBD) might dramatically affect micronutrients status. Objectives We analysed the occurrence of anemia (Hb ≤12 g/dl) and deficiencies of ferritin (Fe, ≤15 ng/dL), vitamin D [25(OH)D, ≤20 ng/ml], vitamin B12 (VB12, ≤200 pg/ml), and folic acid (FA, ≤ 4ng/mL) in ESpA patients. The interplay of MNDs with gender, metabolic parameters, HLA-B27 susceptibility, type of SpA and IBD, disease activity, and treatments was also explored. Methods Selection criteria of this cross-sectional descriptive study consisted of having a diagnosis of ESpA, regardless of its type, in an age of ESpA onset ≥18 and ≤80 years, among patients who were admitted to a combined Gastro-Intestinal and RHEumatologic “GI–Rhe” clinic (Tor Vergata University Hospital, Rome, Italy). Exclusion criteria were represented by active IBD, pregnancy or lactation, kidney and/or liver failure, alcohol abuse, neoplasia, ongoing supplementations. SpA disease activity was assessed by ASDAS-CRP and functional status by HAQ-S. All the enrolled patients underwent blood chemistry analysis to determine parameters including CRP, uric acid (SUA), Fe, 25(OH)D, VB12, FA, and HLA-B27 typing. Results We included 164 patients comprising 109 females and 55 age-matched males. A diagnosis of Crohn’s Disease (CD) occurred in 70% of patients while Ulcerative Colitis (UC) represented a third of the cohort. Peripheral (per) and axial (ax) SpA were equally distributed (50% vs 50%). Patients with ax-SpA displayed a greater prevalence of CD than UC (p=0.02) while UC was prevalent in per-SpA (p=0.02). B27 + was revealed in 19% of our cohort: B27 + patients had a higher prevalence of ax-SpA (p=0.016) and a more severe disease activity (p=0.02) than B27 - . Moreover, B27 positivity and uveitis were prevalent in ax-SpA compared to per-SpA (p=0.009 and p=0.01, respectively). According to univariate analysis, males showed higher SUA (P=0.004) and BMI (p=0.03) than females. Conversely, females showed a higher prevalence of anemia than males (p=0.002). A third of ESpA cohort showed FA (31.6%) and 25(OH)D (27.8%) deficiency while VB12 defect was less frequent (18.2%) and was registered almost entirely in B27 - ESpA (p=0.02). CD-ESpA showed a lower mean VB12 (p=0.04) and a higher prevalence of ocular/skin co-morbidities (p=0.02) and ax-SpA (p=0.04) than UC-ESpA. Accordingly, CD-ESpA were on bDMARDs more than UC-ESpA (p=0.04). Conclusion Our findings document that FA and 25(OH)D deficiencies represent the main MNDs among ESpA patients while VB12 seems to be deficient mostly in patients with CD and almost exclusively in B27 - patients. Otherwise, B27 + in ESpA results to be associated mainly with disease phenotype and treatments. In ESpA, the gender of patients appears to impact principally on dysmetabolism highlighting the role for nutritional interventions particularly in males. The interplay of MNDs with B27 and dysmetabolism in ESpA deserves further investigations also taking into account CD/UC localization and behavior. References [1]Park YE, et al. Incidence and risk factors of micronutrient deficiency in patients with IBD and intestinal Behçet’s disease: folate, vitamin B12, 25-OH-vitamin D, and ferritin. BMC Gastroenterol. 2021;21(1):32.doi: 10.1186/s12876-021-01609-8. [2]Conigliaro P, et al. Impact of a multidisciplinary approach in enteropathic spondyloarthritis patients. Autoimmun Rev. 2016;15(2):184-90.doi: 10.1016/j.autrev.2015.11.002. Disclosure of Interests None declared